Thousands of high-risk patients with severe aortic stenosis go untreated each year because they are deemed inoperable for conventional, open-chest/open-heart surgical heart valve replacement. In an attempt to treat these patients, collapsible prosthetic heart valves have been developed to be inserted within the stenotic leaflets of these patients via transapical (i.e., through the apex of the heart) or other means that are less invasive than full open-chest, open-heart surgery. (See, for example, P. Tozzi et al., “Endoscopic off-pump aortic valve replacement: does the pericardial cuff improve the sutureless closure of left ventricular access?”, European Journal of Cardiothoracic Surgery 31 (2007) 22-25, available online 6 Sep. 2006.) For convenience herein, all such approaches that involve passing a collapsed prosthetic heart valve through a relatively small tubular instrument in order to get the valve into the patient to the desired implant site (where the valve is re-expanded to its operable size) may be referred to as transcatheter approaches. It will be appreciated that the tubular valve-delivery instrument employed can be catheter-like, trocar-like, endoscope-like, laparoscopic or of any other generally similar construction.
Currently a purse string suture is tightened to close off the apex of the heart (or other tissue structure being used for access) after that tissue has been punctured. However, existing methods and devices may not sufficiently address several issues, such as: (1) blood loss and optimal field of view, (2) friable tissue, (3) time and quality of sealing, (4) air embolization, etc. The designs of this invention are transcatheter designs that deliver high-risk patients with a prosthetic heart valve and subsequently seal the apex or other access without many of the associated possible difficulties.